Abstract
BackgroundA Mediterranean-style eating pattern is consistently associated with a decreased diabetes risk in Mediterranean and European populations. However, results in U.S. populations are inconsistent. The objective of this study was to assess whether a Mediterranean-style eating pattern would be associated with diabetes risk in a large, nationally representative U.S. cohort of black and white men and women.MethodsParticipants from the Atherosclerosis Risk in Communities study prospective cohort without diabetes, cardiovascular disease, or cancer at baseline (visit 1, 1987–1989; n = 11,991) were included (mean age 54 years, 56% female, 75% white). Alternate Mediterranean Diet scores (aMed) were calculated using the mean dietary intake self-reported at visit 1 and visit 3 (1993–1995) or visit 1 only for participants censored before visit 3. Participants were followed from visit 1 through 31 December 2016 for incident diabetes. We used Cox regression models to characterize associations of aMed (quintiles as well as per 1-point higher) with incident diabetes adjusted for energy intake, age, sex, race and study center, and education (Model 1) for all participants then stratified by race and body mass index (BMI). Model 2 included potential mediating behavioral and clinical measures associated with diabetes. Results are presented as hazard ratios and 95% confidence intervals.ResultsOver a median follow-up of 22 years, there were 4024 incident cases of diabetes. Higher aMed scores were associated with lower diabetes risk [Model 1: 0.83 (0.73–0.94) for Q5 vs Q1 (p-trend < 0.001) and 0.96 (0.95–0.98) for 1-point higher]. Associations were stronger for black vs white participants (interaction p < 0.001) and weaker for obese vs normal BMI (interaction p < 0.01). Associations were attenuated but statistically significant in Model 2.ConclusionsAn eating pattern high in fruits, vegetables, whole grains, legumes, nuts, and fish, and moderate in alcohol was associated with a lower risk of diabetes in a community-based U.S. population.
Highlights
1234567890():,; 1234567890():,; 1234567890():,; 1234567890():,; Introduction A Mediterranean-style eating pattern (Mediterranean pattern) is one of the eating patterns recommended by the American Heart Association, American College of Correspondence: Casey M
Mediterranean and European populations tend to be less racially and ethnically heterogeneous, have lower body mass indexes (BMI), be less sedentary, have larger social networks, and place a greater emphasis on rest and sleep compared to the general U.S population[12,13]
Participants in higher Alternate Mediterranean Diet scores (aMed) score quintiles were qualitatively more likely to have a higher education, have a higher physical activity level, were less likely to be current smokers and less likely to be obese compared to participants in lower aMed score quintiles (Table 1)
Summary
Introduction AMediterranean-style eating pattern (Mediterranean pattern) is one of the eating patterns recommended by the American Heart Association, American College of Cardiology, and the Dietary Guidelines for Americans to reduce chronic disease risk[1,2]. Evidence regarding how Mediterranean pattern adherence can improve diabetes risk for U.S populations is inconsistent[11]. In Mediterranean and other European settings, adherence to a Mediterranean pattern is consistently associated with a reduced risk of diabetes[14,15,16]. Research is needed to assess whether potential benefits of a Mediterranean pattern are translatable to heterogeneous populations which place less emphasis on ideologies and behaviors of Mediterranean-like cultures. A Mediterranean-style eating pattern is consistently associated with a decreased diabetes risk in Mediterranean and European populations. The objective of this study was to assess whether a Mediterranean-style eating pattern would be associated with diabetes risk in a large, nationally representative U.S cohort of black and white men and women
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